Exploring Factors Influencing Patients’ Embarrassment and Feelings of Imposition in Objective Structured Clinical Examination Interactions

Abstract

ObjectiveTo identify factors influencing patient responses in potentially sensitive situations that might lead to embarrassment (defined by politeness theory (PT) as positive face-threatening acts [FTAs]) or a sense of imposition (defined by PT as negative FTAs) during Objective Structured Clinical Examinations (OSCEs) and to assess the participant’s ability to mitigate such situations. MethodsNineteen OSCE video recordings of 10 pharmacy trainees interacting with mock patients were examined using the PT framework. All relevant participants’ speech acts were coded and quantified into type of FTAs and the mitigation strategies used. Patient (assessor) responses were classified then quantified into preferred responses (ie, quick response) vs dispreferred (ie, delayed or hesitant responses) using conversation analysis. The chi-square test was used to identify any association between relevant variables according to predefined hypotheses using SPSS version 27. ResultsA total of 848 FTAs were analyzed. Participants failed to meet patient face needs in 32.4% of positive FTAs, in 11.5% of negative FTAs, and 44.4% of positive and negative FTAs. Although patients disclosing information about any inappropriate lifestyle behavior (as per OSCE scripts) expressed these via dispreferred mannerisms, participants were less likely to provide patients with reassurance when patient face needs were challenged in this way (68.2% of these dispreferred responses were not given reassuring feedback) than when they were maintained. ConclusionImproving educational programs to include the context of patient face needs and conversational strategies for properly dealing with highly sensitive situations was suggested as a way to equip trainees with the skills to effectively build rapport with patients.